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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Toby on December 1, 1998, at 15:57:45
I just saw a patient with Xanax abuse/dependence and depression/anxiety due to grief over the death of her husband last year in a tragic car accident. No history of mania, other depressions, no family history of anything. She got out of a drug rehab 3 days ago on Prozac, Neurontin and Zyprexa. She was not told what the latter two meds were for, except "for sleep." She feels bad physically, has gained 25 pounds, is sedated and irritable. Still anxious, not as depressed, working a good program in NA, ready to work through her grief. The doc in the rehab program told her this combination of medication would "keep her clean." Would anyone care to comment on this recent practice of putting recovering patients on $350 worth of medications per month without either a diagnosis that is related to the medication or telling them what the medication is really for? Is anyone really finding that this kind of combination "keeps them clean" if there really isn't a bipolar or psychotic illness present? I'm just wondering if I'm out of the efficacy loop or too conservative or what.
Posted by Dr. Bob on December 1, 1998, at 17:07:33
In reply to question for the docs, posted by Toby on December 1, 1998, at 15:57:45
> I just saw a patient with Xanax abuse/dependence
> and depression/anxiety due to grief over the
> death of her husband last year in a tragic car
> accident. No history of mania, other
> depressions, no family history of anything. She
> got out of a drug rehab 3 days ago on Prozac,
> Neurontin and Zyprexa. She was not told what the
> latter two meds were for, except "for sleep."I think the most direct way to deal with this would
be to talk to the doctor at the rehab program.
Otherwise, it's all speculation.It *is* possible to speculate, though... Maybe they
were concerned about hypomania or mood lability or
axis 2 features? Or maybe they elicited a different
history?Separate issues, of course, are how it was
explained to her and how much the medications
cost...Bob
Posted by Nancy Birkner on December 1, 1998, at 19:08:04
In reply to Re: question for the docs, posted by Dr. Bob on December 1, 1998, at 17:07:33
>No history of mania, other depressions
>She was put on Prozac, Neurontin and Zyprexa.
>She was not told what the latter two meds were for, except "for sleep."
> I think the most direct way to deal with this would be to talk to the doctor at the rehab program.
> It *is* possible to speculate, though... Maybe they were concerned about hypomania or mood lability (axis 2 features)? Or maybe they (the rehab doctors) elicited a different history?
My personal experience with Prozac was a severe reaction of ultra-rapid cycling and mixed states. Prior to consuming Prozac, never in my life had I experienced these symptoms. It has been documented by other psychiatrists that Prozac possesses the ability to induce bipolar manic symptoms (in a person with bipolar tendency) when not used in conjunction with mood stabilizers.Actually, what Dr. Bob said about the concern for the appearance of hypomania or other such axis 2 symptoms, was what similarly happened to me. It wasn't until I'd taken Prozac that the depression I suffered from was reassessed as Bipolar 1 illness, with Prozac induced ultra-rapid cycling and mixed states. Unfortunately, it was too late to undue the damage done. The condition lasted many months (early spring of 1997 until April 1998) completely treatment resistive until I underwent a drug trial for Ziprasidone (Zeldox).
Your patient believed that she had been prescribed Neurontin and Zyprexa for her insomnolence. It is not logical for these two powerful neuroleptics to be prescribed only for the purpose of the side-effect producing sleepiness. So, once again, Dr. Bob may have deduced correctly, when asserting that the rehab docs were concerned about underlying bipolar tendency in this patient.
Perhaps, this patient could obtain a copy of her medical record regarding this subject matter. For good reasons, including treatment compliance, a patient would be wise to obtain some understanding of her disorder, treatment options, and the consequences in refusing appropriate medication pertaining to her particular mental illness.
Finally, I'm very empathetic to your patient's tragic loss. But, she should not resort to self-medication. It only leads to more tragedy. It also stands between her and her ability to process her grief.
Perhaps, when my bipolar illness is under control, I'll finish my application to medical school. All I can do, now, is disclose my base of personal knowledge from experiences and research.
Mind Over Madness,
Nancy
B.A. Chemistry, U. of Nevada
Graduate Research in Neuroscience, U. of Nevada
Currently, I guess, I'm a mad scientist.
Posted by Dr. Bob on December 1, 1998, at 20:41:50
In reply to Re: question for the docs, posted by Nancy Birkner on December 1, 1998, at 19:08:04
> Currently, I guess, I'm a mad scientist.
:-)
Kay Jamison, another scientist, refers to herself
sometimes as being "mad", too...Bob
Posted by Nancy on December 2, 1998, at 11:50:05
In reply to mad scientist, posted by Dr. Bob on December 1, 1998, at 20:41:50
> > Currently, I guess, I'm a mad scientist.
> :-)
> Kay Jamison, another scientist, refers to herself
> sometimes as being "mad", too...
Thank you, for the reference. Dr. Jamison is a very talented scientist and an excellent author.
Fellow Mad Scientist,
Nancy
This is the end of the thread.
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